Wednesday, August 24, 2011

Terms ever med student should know

Some of us like debating. Something about the challenge of presenting a point so persuasive that you can change people’s minds on a subject. Often it’s the ability to look at something from a novel new angle which is the best way to win over someone to your viewpoint. Perhaps the most vital strategy, for obvious reasons, is speaking the same language everyone else is using. I speak English and Spanish, but much more the former than the latter. I could definitely understand the debate in Spanish and I could respond on some level, but being eloquent is an entirely different matter.

This comparison to Spanish carries over to medical lingo. Most of us have no idea what all the terms thrown around rapidly really mean. We hear things like CMS, SGR, and Tort reform and have no clue what they really mean. While fully explaining the nuances of all these things can, and likely would, take thousands of lines of text, a few sentence summary will suffice. Below you’ll find a crash course summary of some of the important terms every medical student should know, for no other reason than you will hear them and they will directly affect your medical career. Some might be simple, but this list is about making sure we all know the basics to understand this material, if you want to be an expert in it, do a Google search.

Centers for Medicare & Medicaid Services (CMS): A section of the federal government that basically oversees Medicare, Medicaid, and all other state and national health insurance initiatives. They are the oversight for HIPAA as well. Important to students as residency payments and availability comes from the decisions CMS makes each year after monitoring the residency environment each year. They are the source of your money for residency.

Graduate Medical Education (GME): A term for both the period of time one is a resident and the amount of money set aside in Medicare for paying residents. GME has been capped since 1997. GME can come from other sources than Medicare (e.g. Veterans Affairs funds make up 9% of total US GME) , but it is overwhelmingly directly from Medicare.

Balanced Budget Act of 1997: A law that cut $112 billion from Medicare, including $44 billion directly from payments for services. It also put a cap on the amount of funded residencies Medicare would support. That cap has not increased since 1997, though creative accounting and money reallocation has allowed for at least a 7.6% increase in residency spots since then. New residency programs must gain funding by: diverting funding from another residency to the new one, utilize a loophole (e.g. a small number of new residencies are allowed in rural areas each year), or find independent funding.

Sustainable Growth Rate (SGR): A program put into effect after the Balanced Budget Act of 1997 which limits how much physicians are allowed to spend per Medicare patient, regardless of illness. While the SGR does not limit spending on an individual patient basis, it measures the amount of money spent by Medicare per patient in the year and punishes or rewards doctors based on what percent of GDP it is. Physicians have rarely ever functioned under the proposed yearly spending limit and it has only been through deal cutting that payments cuts that accrue each year are never enforced. Recently the government decided to enforce the cuts, a 21% cut in all physician payments. This cut was delayed until 2012 (when it will be at least 23%). SGR is currently one of the most strongly opposed policies by the AMA, as they feel the entire system is flawed and will only lead to a choice between pay cuts or under-treating patients.

Tort Reform: Also known as malpractice reform. Tort law is involved with wrongs done against individuals which break no contract or existing criminal law. The relevant portion of tort law is medical malpractice, which generally falls into the category of negligence. It is believed that the constant risk of being sued leads to a drain on the system where physicians perform extra tests they do not feel are necessary, both protecting them from liability and charging the patient for things they likely didn’t need done. Similarly malpractice insurance is a huge drain on physicians (OBGYN malpractice cost for basic coverage go as high as $142,000 per year, with NY being among the most expensive states). Physicians argue limiting potential winnings and/or the ability to file frivolous lawsuits would lessen the need for “defensive medicine” and make medicine more cost efficient. Lawyers argue any limitation on winnings or ease of filing will deprive those truly injured from getting their compensation.

New York Medical Liability Reform: The budget office of NY, which contains no medical personnel, identified medical malpractice reform as one of the key ways to balance the NY State budget in 2011. Their plan would cut as much as 25% off of malpractice insurance costs, put a cap on the maximum “pain and suffering” award (only a portion of the total award), create a fund specifically for newborns with birth injuries,  and put safeguards up to prevent frivolous lawsuits. These changes were expected to cut huge amounts of cost from the budget as much of the cost of malpractice is a state burden through the public hospitals being sued and performing “defensive medicine.” The budget bill met strong opposition from the Trial Lawyer Association and the medical liability reform portions were eventually cut from the bill before it passed.

NYC Health and Hospitals Corporation (HHC): A “public benefit corporation” that is run as a private company, but primarily state funded (similar to how power companies work). HHC is the single largest hospital system in America. It operates 11 hospitals, 4 nursing homes, 6 diagnostic centers, and over 80 medical offices in New York City. It also runs MetroPlus, the New York City branch of Medicaid. HHC has been in the news recently for its difficulty keeping profitability, a serious issue for a state-funded organization that is likely to leech money rather than ever fold. HHC was also in the news a few years back for a $100 million deal with St. George’s Medical School in the Caribbean where it sold clerkship spots, some of which were occupied by New York-trained students, to the highest bidder. Although the broker of the deal within the HHC board stepped down after admitting to breaching ethics to broker the deal, the HHC continued with the deal anyway for financial reasons.

International Medical Graduate (IMG): A student trained overseas that comes to America to practice. Frequently divided in conversation between FMG and US-IMG. Foreign Medical Graduate (FMG) is a term that is technically interchangeable with IMG, but is generally used to convey that the student is foreign-born as well as foreign-trained. This terminology generally is never applied to Canadians or Americans who trained in Canada, as they are treated as US trained physicians in most casual senses. US-IMG is a term used when one wishes to specifically refer to American citizens who travel to a different country to earn their medical degree before returning to the US for residency. The large majority of US-IMGs attend one of the 17 "offshore american" schools in the Caribbean.

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